Mosaic approach for monitoring Healthy People 2020 objectives:

Transcription

1 Mosaic approach for monitoring Healthy People 2020 objectives: A substance abuse surveillance system Karilynn Rockhill 1, Gabrielle E. Bau 1, Matthew S. Ellis 2, Theodore J. Cicero 2, Richard Dart 1 1 Rocky Mountain Poison & Drug Center, Denver Health and Hospital Authority, Denver, CO 2 Department of Psychiatry, Washington University School of Medicine, St. Louis, MO

2 Disclosure The RADARS System is supported by subscriptions from pharmaceutical manufacturers, government, and nongovernment agencies for surveillance, research, and reporting services. RADARS System is the property of Denver Health and Hospital Authority, a political subdivision of the State of Colorado. Denver Health retains exclusive ownership of all data, databases and systems. Subscribers do not participate in data collection nor do they have access to the raw data.

3 Background Healthy People 2020 Objectives National 10-year objectives for improving and monitoring the health of all Americans Problem Rapidly changing drug use environment Lack of repeatable yet flexible data instruments Able to provide timely data Ability to adapt questions on surveys Need for real time surveillance

4 HP 2020: Substance Abuse Objectives SA 7: Increase the number of admissions to substance abuse treatment for injection drug use Goal of a 10% improvement SA 13.3: Reduce the proportion of adults reporting use of any illicit drug in the past-month Goal of a 10% reduction Disparities of interest: age, race/ethnicity SA 19: Reduce the past-year non-medical use of prescription drugs Disparities of interest: age, race/ethnicity, veteran status

5 Study Objective Provide progress on three indicators using two RADARS System Data Sources Treatment Center Programs Combined Survey of Non-Medical Use of Prescription Drugs Program Demonstrate how these data sources can be used to monitor these indicators

6 RADARS Surveillance System: Mosaic Approach Since 2016 Since

7 Treatment Center Programs Combined: Data Collection Methods Overall Design Newly admitted patients seeking treatment for opioid use disorder Two data collection systems combined with a standardized selfadministered questionnaire Opioid Treatment Program Persons entering federally-approved medication-assisted programs 71 active programs in 33 states Survey of Key Informants Patients Program Persons entering primarily private treatment centers 125 Key Informants in 45 states Definition/Type of Cases Past month abuse prevalence and injection rate of prescription opioids, heroin, and non-opioid drugs 7

8 Treatment Center Programs Combined: Analytical Methods Study Period 2011 through 2017 Key Measure Report of injection of a drug at time of treatment admission Report of use of any illicit drug in the past month (cocaine/crack, methamphetamine [crystal meth], hallucinogens, heroin, or MDMA) Regression Logistic regression with a random intercept on participating centers used to calculate odds ratio of respondents who report injecting a drug in 2017 compared to 2011 Stratified by age and race/ethnicity 8

9 Survey of Non-Medical Use of Prescription Drugs Program: Data Collection Methods Study Design Semi-annual repeated, cross-sectional online survey Population/Sampling General population of adults recruited from a survey panel Quota sampling proportional to census region and 50:50 male/female Sample size 63,042 adults in 2017 Definition/Type of Cases Non-medical: use of a medication without a doctor s prescription or for any reason other than what was recommended by a doctor Opioids indicated for pain Illicit drug use in past month 9

10 Survey of Non-Medical Use of Prescription Drugs Program: Analytical Methods Post-stratification Weighting Weights are applied to reflect distribution of adults in the US Census region NE, MW, S, W Gender Age categories 10 year categories Prevalence Estimates National estimates and 95% Confidence Intervals (CI) Stratified by age, race/ethnicity, veteran status Population-Based Rates, State Heat Maps Weighted estimate of the number of adults for each measure per 100,000 adult population 10

11 Treatment Center Programs Combined Injection Drug Use in Past Month Proportion of Respondents Odds Ratio: 1.15 (95% CI: 1.02, 1.30) Q3 2011Q4 2012Q1 2012Q2 2012Q3 2012Q4 2013Q1 2013Q2 2013Q3 2013Q4 2014Q1 2014Q2 2014Q3 2014Q4 2015Q1 2015Q2 2015Q3 2015Q4 2016Q1 2016Q2 2016Q3 2016Q4 2017Q1 2017Q2 2017Q3 Year-Quarter SA 7: Increase the number of admissions to substance abuse treatment for injection drug use

12 7.0 Treatment Center Programs Combined Change in Odds of Illicit Drug Use 2011 to 2017 in Past Month Odds Ratio (95% Confidence Interval) SA 13.3: Reduce the proportion of adults reporting use of any illicit drug in the past-month

13 30 Survey of Non-Medical Use of Prescription Drugs Program 2017 National Prevalence of Illicit Drug Use in Past Month 25 Prevalence (95% CI) SA 13.3: Reduce the proportion of adults reporting use of any illicit drug in the past-month

14 Survey of Non-Medical Use of Prescription Drugs Program Any Illicit Drug Use Past Month Population based rates per 100,000 adults SA 13.3: Reduce the proportion of adults reporting use of any illicit drug in the past-month

15 2017 National Prevalence of Non-Medical 25 Survey of Non-Medical Use of Prescription Drugs Program Use of Pain Relievers in Last Month 20 Prevalence (95% CI) SA 19: Reduce the past-year non-medical use of prescription drugs

16 Survey of Non-Medical Use of Prescription Drugs Program Non-Medical Use of Pain Relievers Use Past Month Population based rates per 100,000 adults SA 19: Reduce the past-year non-medical use of prescription drugs

17 Disparities of Interest Gender Geographic Region Age Race/Ethnicity Income Marital Status Education Student Status Veteran Status Healthcare Professional Status Pregnancy Chronic/Acute Pain History DAST-10 Score

18 Conclusions The RADARS System mosaic approach can compliment existing data to evaluate the Heathy People 2020 objectives Assessing progress on the objectives can be made in near real-time with various RADARS System data Treatment Center Programs Combined has data dating back to 2009 to assess trends Survey of Non-Medical Use of Prescription Drugs Program began data collection in 2016Q3 and will continue semi-annually

19 Questions Karilynn Rockhill, MPH Biostatistician II